Typical day for a Home Health nurse... - page 25

Not a bad day today... started back per diem today. 6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line like... Read More

  1. Visit  MyUserName,RN profile page
    So I thought I'd revive this thread again. I'm thinking of leaving my home health job. I've been doing it for almost 2 years now. Have really loved home health, but the charting, the never being "off" work feeling, I feel like I'm working so much that even though I'm making a lot more money than I did in the hospital, I think if I broke it down hourly, I'd be making a pretty low amount. I was very burnt out on working on the floor at the hospital and thought I'd never want to go back to that again. But it was my first hospital job. I never tried any other floors or any other hospitals. The things I miss about the hospital are working 3 12's and being off 4, when you're off, you're off. I feel like I had more free time for my family......so here's my day yesterday. I wasn't on my "A" game yesterday that's for sure, but here goes...

    Dropped my kids off at the baby sitters house at 745. Went to the coffee shop to connect to the internet and get caught up on some charting from the day before. Charted, ordered supplies, made calls to dr's, adjusted my schedule, called patients, calls to office etc, until 1130. (Working, but not getting paid for this time). Saw my first patient at 12pm....did not want to start this late, but had to get that stuff done. This visit was very involved, lots of wound care, picc line dressing change, calls made to MD. Spent an hour in home and didn't get any of pts charting done. Routine visit. Drove to next visit, was an admit, got to house, realized that I didn't have consent paperwork....great. Had to drive to the office to pick up paperwork before I could made SOC visit, this was 40 min out of my time. Called patients home, let them know I'd be late, they said fine...Drove back to patients home, arrive to do SOC, patient very HOH, very agitated, said he didn't want home health, refused my services.....Okay, so I just wasted at least an hour, maybe more of my day, for a SOC that I don't get paid for.

    On to the next house, this patient never answered the phone today, so I just showed up. She wasn't expecting me, but let me in anyways. Just a routine/sup visit, checked on meds, made sure she was taking the right coumadin dose that had recently changed, instructed on bleeding precautions. Everything was good with her and I was on my way. Still didn't get any of her charting done because I was in such a hurry to get to the next patient, by this time, I'm behind on time. It's about 3pm at this point. So I drive to my next house, routine/supervision visit with wound care. I arrive at home, nock and nock, nobody answers. Soon realize I'm at the wrong house. Lol! Go to the right house. Open my trunk and realize, I don't have my nursing bag!!! What!? I left it at the last house I was at....OMG! I have never done that before. Seriously, what else can go wrong with this day?! Drive back to the last house, pick up bag, go back to patients house and complete the visit....now it is 4pm. I called the next patient who hasn't answered the phone all day. Finally, somebody picks up. They inform me that patient has moved out of state with another family member and they don't know when patient will be back. Okay, so that's a non visit discharge....put that off till later. So I looked at the next days schedule to see if anyone else can be seen today. Move a patient over, go see her, take care of business with her. Day is over....except that I'm on call tonight and have an IV SOC that has to be done no earlier than 945pm. So I go to baby sitters house, see the kids for a little while, eat dinner, and then head out to the SOC that is about an hour away. Do the SOC, admin the IV, teach family how to do. Charting put off until tomorrow. Get home about 11 pm, kids stayed the night at baby sitters house since it was so late and had to drop them off early in am anyways.

    So that's my day yesterday. Oh and I stepped in dog poop. I didn't eat lunch, didn't stop to go pee and was busy all day long. It was a great day. (Sarcasm!) So looking back, I was working from about 830am to 11pm with a 2 hour break in between the night visit. So I worked for about 13 hours, still have tons of charting to do from yesterday, which will take me who knows how many hours to complete, but only got paid for 4 routine visits and a SOC. Now when I break that down.....the money is not very good. I know not every day is like that, but, it seems lately, I'm having more days like that than not. It's like a downward spiral, if one day is bad and you are behind on charting, the whole rest of the week follows suit. Anyways, as much as I love a lot of things about home health. I miss my kids. I hate being home and having to shew them away all the time because I'm trying to get charting done.

    Sorry for such a negative post. I just needed to vent.
  2. Visit  MyUserName,RN profile page
    Quote from Libby1987
    Entirely depends on the preceptorship, a new grad isn't remotely prepared for the independent nursing judgement and decision making required of a nurse working alone in the field. At some point telephone consults will suffice but not initially.

    They may tell you that they will give you the easy non complicated cath changes and staple removals, but I doubt that'll stick, not when there are visits needed to be made and you're available. (If anyone could get a job just doing the easy visits they would get beat up after school..)

    Home health has a rep for being easy, it's not, not logistically, documentation wise or responsibility wise. Those sick patients that are discharged home barely stable? That's who you will be seeing. The number of patients I've sent back for sepsis with admission to ICU or acute CHF (and the pressure is on for us to prevent that) has increased dramatically in recent years. You want to make sure that isn't because you missed something.

    So my advice is don't let anyone jack with your liability, if you aren't offered a solid orientation, don't accept.
    YES! I have sent so many patients to the ER only of them to be admitted to the ICU. Very sick. I could not have done home health without my med/surg experience. You just have to have that nursing knowledge that only experience can give you.
  3. Visit  Libby1987 profile page
    MyUserNameRN, that was a sucky sucky day and I completely commiserate. I love home health and thrive in it but I know those days and if I couldn't get enough time at home with my kids I'd be exasperated and looking for something more workable too.

    My agency doesn't schedule visits for the on call nurse, in fact we don't agree to evening SOC or visits but it is an option for the individual nurse if they choose. (small semi rural retirement area, branch office) I haven't worked a weekend in years though I have to be available should I be needed. My patients are usually relatively close together and I live in my patient territory. The EMR we launched was horrible and it was a rough few months until they scraped it and started over. Mostly it is and has been a good career.

    If there is any possibilty that you can find an agency that has more family friendly scheduling I'd try that. It takes a number of years to maximize your efficiency so if you love the patient care part it may be worth staying with it in an alternative set up.

    Here's hoping tomorrow or at least next week is a whole lot smoother!
  4. Visit  Penholder profile page
    I just started reading this thread and I have to say thank you! I have been a CNA for ages, am currently in school for my RN. For 2 years I did non medical home care scheduling/intake/actual care. As I get closer to finishing school I get more of a feeling that home care suits me. I like the connection. The more I look at doing more time in a facility the more I miss home care.

    My question is what is psych home care? I have worked inpatient psych, so I understand the population. Can someone enlighten me on this?

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